fostering the humanistic practice of medicine publishing personal accounts of illness and healing encouraging health care advocacy

Close this search box.

fostering the humanistic practice of medicine publishing personal accounts of illness and healing encouraging health care advocacy

Close this search box.
  1. Home
  2. /
  3. Stories
  4. /
  5. Cracked Up

Cracked Up

Carlos Downell ~

They say that to write well, you should write about what you know. I’m a homeless drug addict. This essay is not about me, although I’ll figure in it. It’s about drug abuse among the homeless, a subject I’m very well acquainted with.

I have a dual diagnosis–substance-abuse issues and psychiatric dysfunction. Double trouble. If I can’t get meth, I’ll smoke crack, and if I can’t get crack, I’ll smoke pot or take pills or whatever I can get–anything but inhalants. I’m what’s known as a polysubstance abuser. (Most addicts are.)

I’m in recovery. Sounds like I should be in a hospital bed, and perhaps I should–but I continue to function. I abide, I persevere and I survive: It’s what I do. I reside on the sidewalk, on the railroad tracks, under the freeway overpass.

Wherever I end up at the end of my day’s trek, I plant my flag, claim that land in the name of Queen Isabella of Spain, hunker down and make my camp. I bloom where I’m planted.

I’ve been in rehab three times. The last one took, because they showed me something important–something I needed to know. (More on this later.)

I’ve seen people die–right before my eyes. Friends, acquaintances, associates and people I didn’t know, they died. And here’s the irony: They died trying to feel good.

It’s a goddamn shame when a person can’t pry a little love, a little joy, a little peace of mind out of this nut called life. Instead, what so many of us get is pure pain, frustration and hell, distilled into agony, hopelessness and, ultimately, our own demise.

That’s a hell of a switch, ain’t it? We go for love and joy, and we get pain and death.

The ones who died, here’s how they died: They overdosed on heroin; they overamped on crank (powdered amphetamine)–that is, their hearts burst; they mixed heroin with pills. They died of pneumonia, AIDS and hep C. They died of liver failure, liver cancer, kidney failure, pancreatitis, stroke, brain aneurysm and lung cancer. (One of the toughest drugs to kick is nicotine. Old-time, hardcore junkies say it’s harder to quit than heroin.)

I’ve seen a man chug an entire fifth of hard liquor and drop dead on the spot. I’ve seen a dude take a monstrous crack hit and keel over from a massive coronary.

Homeless people are in and out of prison. Drug addicts are in and out of prison. Homeless drug addicts practically live in prison. Eventually, they become “institutionalized”–utterly dependent upon the institution for their survival. This concept is horrific. And it is true. I’ve seen it–and, to some degree, experienced it. But I fight it, goddammit. Because I have to be free, even if it’s only free to starve and do without. Free is free.

If you’re homeless (free) and strung out, you’re still in prison–a prison of addiction. And you carry your prison with you. That’s why it’s useless to try a “geographical cure.” If you’re an addict in Phoenix, you’ll be an addict in Albuquerque. So you’ve got to fight where you stand.

There were these Plains Indians called Dog Soldiers (I’m not sure why) who wore a short sash with a spear attached to one end. They’d drive the spear into the earth. The other end of the sash was attached to their waists, limiting their movement to a small circumference around the spear. They would fight to the death to defend that circle of ground.

People in recovery who really want to recover have to be Dog Soldiers. The stakes are the same, really.

My drug of choice was crystal meth. I don’t like twelve-step meetings, because I get tired of saying “My name is Carlos,” along with the rest of the drill.

Am I grateful to still be alive? Well, maybe….The prospect of continued life is not so bright and wondrous when all you have to look forward to is one soup kitchen or the other, one shelter or the next.

I’ve looked into the eyes of my homeless brothers and sisters and seen the hopelessness there. They move, they live, they breathe; but inside, they’ve given up. Something inside says, You’ll never have a house, a job, a car, a wife, kids, any of that. This is your life: A backpack, a crack pipe, a forty-ounce and a shelter bunk; day after day, night after night, world without end, Amen.

I see it in their eyes. I don’t see it in mine, but I fear that someday I might. As you can imagine, if you spent a day, a week, a month feeling the aforementioned feelings…and if you got some money–say, a day-labor payout or an SSI check–chances are, you’d seek a little solace. You’d solace yourself with a motel room and an eight ball of crack or a syringeful of meth or whatever floats your boat.

This is what I have done; and this is what the homeless do. They’re only human.

But I’ve been clean and sober and off meth for three months now. I haven’t smoked any crack, either. I’ve taken a few pills, but only my prescribed medication–psychotropic salvation.

What I learned at the last rehab was that if you cut drugs out of your life, you’ve got to replace them with something. Otherwise, you’ll be bereft and desolate. An empty, cracked vessel.

But your own body produces substances many times more powerful than the drugs we fought to get and died to take. It produces painkillers as potent as heroin (enkephalins) and stimulants stronger than methamphetamine (adrenaline). It produces endorphins, which I can personally testify are the best drug yet. And the most powerful.

All you have to do is to abstain from illicit drugs, allow your body, mind and spirit (that is, your heart) time to recover from the drugs’ wear and tear, and your body’s natural chemicals will kick in, and you’ll be, if not cured, then the next best thing–restored, renewed, rejuvenated and rehabilitated.

There’s another natural substance the body produces called oxytocin. It occurs when there’s love and trust between two human beings. Boy, that endocrine system is a hell of a thing, ain’t it? I mean, how does it know?

Oxytocin is produced when a mother nurses her baby. Or when there’s camaraderie between friends. It’s a “reward” chemical, one of the forces behind what Freud termed the pleasure principle–that is, we seek pleasure and avoid pain. (Remember, addicts die trying to feel good.) A simple proposition on the face of it, but you’d be amazed at how many people get it wrong. Millions of addicts can’t be wrong, can they? Oh yes they can.

One of the most pathetic things I’ve ever seen was two homeless people in love. I mean, what the hell were they trying to prove? Nothing plus nothing equals nothing. And that’s all they both had: nothing. No house, no job, no car, not a goddamn thing. Maybe a half-can of TOP or Bugler tobacco, plus some ragged, smelly clothes and a shopping cart to tote them around in, and that’s it.

Or was it? Because when these two poor, pathetic homeless tramps put their hearts together, their systems started pumping out the oxytocin and the enkephalins and the endorphins, and they didn’t need anyone else, or really too much of anything. They fulfilled each other’s deepest longings and needs simply through their love for one another and its manifestation–not in fantasy but in reality. And there’s absolutely nothing pathetic about that.

What’s pathetic is those of us who don’t have that, or anything like that. Their love trumps our ridicule and contempt. I’d rather be them than be me, laughing at them, anytime. And that’s what the last rehab taught me.

Way cool, huh?

So when you see a snaggle-toothed old homeless tramp looking for love, whether inside or outside of a shopping cart, don’t fault him (or her) too badly. He’s merely following the prime directive–the pleasure principle–and trying to get his oxytocin straight.

That’s the endorphin challenge, boiled down to its bare essentials: Feel good or die. Sounds stark, but there it is.

I’ve quit smoking for the time being. But I know that if I want that to stick, I’ll have to find something to fill nicotine’s role in my life. I feel pretty good, despite my present circumstances.

And that’s the law of life, isn’t it? Feel good or die.

I choose the former. What do you choose?

About the author, by Janice Mancuso:

In October 2007, Carlos Downell (1954-2012) first entered the doors of the Endorphin Power Company (EPC), an Albuquerque nonprofit that provides transitional housing for recovering alcoholics and addicts. It was my second day as EPC’s executive director.

Carlos was fifty-three years old and had spent half his life incarcerated in prisons or jails. He was articulate and forthright–a blues guitarist, a recovering meth addict and homeless. Early on, he gave me a twenty-page document that he’d written while in prison. I learned that he was a damned good writer, and that he had a story to tell.

Over the following two months, he visited my office daily. Carlos had a keen wit. We laughed a lot and shared our love of books, but mostly I listened to his stories. He could tell I genuinely enjoyed his company; he’d tell me that no one had treated him like a “normal person” in a long, long time.

I don’t remember how the conversation began, but Carlos said he wanted to write a collection of essays about homelessness and addiction. He asked if I would edit his work, and I said I would. His first essay, “Zorro,” blew me away–and blew away everyone else who read it.

Ten days later, Carlos was arrested and jailed for a nonviolent offense. He sent me “Cracked Up” from the Metropolitan Detention Center. He intended it to be the first essay in the collection, which he titled Lost in America.

In a subsequent letter, Carlos wrote: “You know me perhaps better than anyone because I tell you and share things with you that I don’t tell anyone else.” He went on: “If anything happens to me, go ahead and try to have the work published, on your own. Just get [the essays] out there. I wrote them to be read.…Getting the book done is the primary thing, maybe the only thing. No matter what, there’ll be that…to show I was here. My mama said, ‘Son, plant a tree, have a child, write a book.'”

From jail, Carlos sent me 140 essays and almost as many letters over an eighteen-month period. Tragically, his mental health deteriorated over time, and eventually, after his release, I felt I needed to pull back from our relationship out of self-protection.

Carlos Downell died alone in a vacant field in Albuquerque on July 18, 2012. The cause of death was reported as “meth and cocaine,” an accidental overdose.

For all his struggles, Carlos was my friend and teacher, and he forever changed my world view. It was a privilege to know him, and I’m a better person for it. I still hope to assemble and publish Lost in America. I can’t forget what Carlos told me: “Now, it falls to you. I know it’ll take a while, but I have perfect faith in you.”

Janice Mancuso, a continuing medical education conference professional, has worked in the CME office of UC San Diego School of Medicine and served as conference director for the Wilderness Medical Society and as executive director of the Colorado Chapter of the American College of Emergency Physicians. She is the founder of The Osler Symposia, a nonprofit whose mission, through retreats, is to enhance the well-being of physicians and nurses for the betterment of health care, society and humanity.

Story editor:

Diane Guernsey


12 thoughts on “Cracked Up”

  1. I understand pulling back for self-protection,but I think it is a form of a andonment. Surely, somewhere, there was a place for Carlos instead of an empty field. This is the final heartbreak of homelessness.

  2. Elaine Murdock

    Very moving and powerful. So tragic Carlos is unable to
    experience how his words and his life move and enlighten.
    I felt “his voice” and look forward to reading his book. Thank you, Janice, for sharing Carlos’ journey.

  3. Wow! Very touching! As a sibling & in-law of addicts, ACOA, & nurse who’s worked for many years advocating for nurses in recovery, I can see so many of my loved ones in Carlos. I’m sorry that this beautiful creative mind & pen are now silenced.
    Two questions–have his essays been published in a volume? If so, where might we find it?

  4. Joseph fennelly

    Thank you, thank you. Carlos’ “lost in America” has found a voice. As health professionals our empathy is crushed by the sheer force of technology . Where in the EMR unless under the dwarfed space for comments is an add on. What does one do when the armor in our therapeutic stuff enprisons us from the spiritual pain of the ‘other’? We have two challenging odyyseys. One to breath new oxygen into our profession. The other is to journey with those in existential pain. Only through our sense of service can we travel the travail of this road. Thank you again.

  5. Kinda interesting to see and feel what others have behind their eyes, I guess we just have to be willing to go under the overpass to be able to listen.
    Thanks for the gift

  6. What a heart felt piece.I can see why Carlos was a friend and teacher to you, Janice. I hope you can carry out his last wish and get his essays published. This venue is a good start.

  7. Ronna Edelstein

    Wow, what an amazing story–poignant, human, gut-wrenching. Janice, thank you so much for introducing us to Carlos Downell through his powerful words–and profound honesty. May he find in death the peace that eluded him in life.

  8. Janice- I remember your kind comments at least a decade ago after my story on Osler – REPRISE came out, Thank you for your help of Carlos. Quite a story to tell,

Leave a Comment

Your email address will not be published. Required fields are marked *

Related Stories

Popular Tags
Scroll to Top